Behavioral Therapies for Anxiety Disorders

Erin L. George, MFT
Erin L. George, MFT
Medical editor

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Behavioral therapy is a broad term encompassing a variety of techniques used to change maladaptive behaviors and enhance a person's quality of life. Central to this therapeutic approach is the principle that behaviors are learned, so they can be unlearned or relearned through the systematic application of learning principles. This form of therapy is particularly relevant in the treatment of anxiety disorders, as it focuses on identifying and modifying the behaviors and thought patterns that contribute to an individual's anxiety.


By employing specific strategies such as exposure therapy, systematic desensitization, and response prevention, behavioral therapy aims to reduce the symptoms of anxiety, improve emotional regulation, and help develop coping mechanisms that enable individuals to face previously feared situations with increased confidence and less distress. The relevance of behavioral therapy to anxiety lies in its evidence-based approach, emphasizing direct interventions that are tailored to address the specific manifestations of anxiety in each individual. This targeted approach helps clients learn practical skills for managing anxiety, ultimately leading to significant improvements in their daily functioning and overall well-being.

Behavioral Therapy Explained

Behavioral therapy is like a toolbox for fixing unwanted habits and fears. Imagine your mind as a garden, where your behaviors are the plants. Some of these plants are healthy and make your garden beautiful, but others might be weeds that cause trouble and make the garden less pleasant. Behavioral therapy helps you pull out these weeds and plant more flowers instead. It's based on the idea that all behaviors are learned, so if you can learn something, you can unlearn it, too.

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Now, let's make it even simpler. If you're scared of spiders, behavioral therapy might involve spending time around spiders in a controlled way so you learn they're not as scary as you thought. This is done step by step, starting from just thinking about spiders to looking at pictures and, eventually, being in the same room with one. Over time, your fear fades away because you realize nothing bad happens when you're around spiders. This is called exposure therapy, a key tool in the behavioral therapy toolbox.

Contrast this with Cognitive Behavioral Therapy (CBT), which resembles a more advanced toolbox. CBT agrees that behaviors are important but also focuses on how your thoughts and beliefs shape your feelings and actions. It's like looking at both the soil and the plants in your garden. CBT teaches you to identify and change negative thoughts (weeds) into positive, realistic ones (flowers), which can make you feel and act better. For example, if you think, "Every spider will harm me," CBT helps you challenge that thought and replace it with something like, "Most spiders are harmless and afraid of humans."

Other therapy modalities focus on different aspects of the garden. For instance, psychodynamic therapy digs deep into the soil to uncover the roots of the weeds—your unconscious thoughts and early life experiences that may be influencing your behavior now. Meanwhile, humanistic therapy focuses on the garden's potential for growth and encourages you to cultivate your personal values and strengths.

Core Types of Behavioral Therapies for Anxiety

Exposure therapy

The effectiveness of exposure therapy relies upon a behavioral concept called habituation. Habituation is the process by which a person's behavioral and sensory responses diminish over time after repeated exposure to particular stimuli. We've all experienced habituation. Have you ever visited friends who lived near an airport, a busy highway, or a train station? You may wonder how they can possibly concentrate or sleep with all that noise. Your friends may have felt the same way when they first moved in. However, after living there for a while, their sensory neurons stopped reacting to the noise. They will probably tell you that they are so accustomed to the noise they no longer even hear it. They've become habituated to it. Similarly, have you ever jumped into an ice-cold swimming pool only to feel comfortable after a few minutes? That's habituation at work.

Exposure therapy may be conducted using in vivo exposure (meaning live exposure to the feared stimulus). It can also be conducted using imagination or both. The use of imagination is particularly useful in cases of trauma or in other occasions where in vivo exposure is not practical. When imagination is used, the therapy is most effective when all five senses are included in the guided therapeutic exercises. Whether in vivo exposure or imaginal exposure, individuals are encouraged to repeatedly face the anxiety-producing stimulus until habituation occurs. In this way, they no longer experience the same degree of anxious distress.

Once habituation occurs, the fearful behavior will eventually be extinguished. This concept is based on classical conditioning. Evidence suggests that individuals learn to become afraid of neutral stimuli (needles, doorknobs, rats, etc.) as a result of the paired association between a neutral, conditioned stimulus (CS) and fear-inducing stimuli (UCS). A behavior will be extinguished (i.e., the fear is eliminated) simply by reversing that process. In other words, the fear can be eliminated by unlearning, or un-pairing, the association between the CS and UCS. For example, a person with social anxiety (social phobia) may associate parties with the dread of excruciating embarrassment. By repeatedly facing social situations, the person can learn that nothing terrible happened. Then, the fear will be extinguished.

Erin L. George, MA-MFT, explains, "People with moderate to severe anxiety disorders may be reluctant to try behavioral therapy because of the triggering thought of exposure therapy. Rest assured, therapists and other mental wellness professionals understand how scary facing your fears can be. Exposure therapy is done in slow stages and isn't something a client will be expected to be ready for in their first few sessions. If you decide to try this type of therapy, it's important to be honest with your therapist about your concerns and to keep in mind that it's okay to say no."

Systematic desensitization

Causing people to remain in the presence of fearful situations is called exposure therapy. It is a highly effective and efficient way to treat anxiety. However, as you might imagine, it is difficult to get people to agree to this method.

A variant form of exposure therapy is called systematic desensitization. This technique avoids overwhelming anxious people. First, they are taught age-appropriate relaxation methods. This helps them learn to relax in the presence of fearful situations. After relaxation has been mastered, they are gradually exposed to progressively more intense experiences of the situations they fear. This may include both imaginal and actual exposure.

For instance, suppose someone is afraid of elevators. First, they may be asked to practice their relaxation techniques while looking at a picture of an elevator. Next, they may be asked to relax while imagining getting into an elevator. Next, they may practice relaxation as they step on and off a real elevator. Next, they may step on, allow the door to close and reopen, and then get off. Finally, they may ride up one story, etc. This gradual, systematic approach enables them to become desensitized to the fearful situation.

Response prevention

A component frequently coupled with exposure therapy is called response prevention. As the name implies, response prevention means discontinuing maladaptive coping responses such as avoidance and escape.

Exposure and response prevention is an effective treatment for anxiety disorders. Its effectiveness rests on scientific principles tested in laboratory research (Deacon & Abramowitz, 2004; Norton & Price, 2007; Stewart & Chamblass, 2009). More specific examples of these treatment methods can be found in the Treatment of Anxiety Disorders Section.

Very recently, emerging research has forced researchers to rethink the classical learning theory model to accommodate new insights into how memory functions. It was believed that once a memory was established, that memory was more or less permanent. It turns out that memories aren’t very permanent structures at all. Rather, memories are structures that can be edited and changed under certain circumstances.

Erin L. George, MA-MFT, says, "One way to think of memories is to think of the ways people tell stories or recount events based on their mood, audience, situation, or life stage. What seems traumatic at one point may become a funny story 20 years later. Likewise, something that still seems traumatic down the road will very often lack the same details it once had, and details may even change based on the storyteller's current state of mind or environment. There are also many ways to view the exact same memory as a person develops coping skills they can often gain through behavioral therapy."

This process of editing previously established memories has been termed "memory reconsolidation." This term derives from the concept that when a memory is first established, that process is a "consolidation." Research has increased our understanding of how to manipulate the reconsolidation process. This led to the development of experimental forms of memory reconsolidation therapy. These promising therapies appear to effectively and quickly alter emotional memories, including those associated with certain anxiety disorders. More information on these experimental therapies is provided here.

The Behavioral Therapy Experience

Embarking on behavioral therapy is a courageous step toward self-improvement and healing. Understanding what to expect can help alleviate any apprehensions you may have and prepare you for the journey ahead.

What to Expect During the First Session

The first session of behavioral therapy is about laying the groundwork for future work together. It's a get-to-know-you session where your therapist will likely:

  • Discuss confidentiality: Your therapist will explain the confidentiality agreement, ensuring you understand that what you share in therapy stays private, with few exceptions for safety concerns.
  • Gather information: Expect to discuss your medical, psychiatric, and social history. This conversation helps the therapist understand your background and the factors contributing to your current situation.
  • Identify concerns: You'll talk about what brought you to therapy, including any specific behaviors, symptoms, or situations you want to change.
  • Explain the therapy process: The therapist might outline how behavioral therapy works, including the use of techniques such as exposure therapy, systematic desensitization, or response prevention.
  • Set expectations: You'll address session frequency, duration, and the therapy's overall structure.
  • Begin to build rapport: The first session is also about establishing a therapeutic relationship. It is important you feel comfortable and safe with your therapist.

Assessment and Goal Setting

After the initial session, the next few sessions will likely focus on a more detailed assessment. This process involves:

  • Understanding behavioral patterns: Through discussion and possibly standardized assessments or questionnaires, your therapist will work with you to identify specific behaviors and situations that trigger anxiety or other unwanted responses.
  • Setting goals: Together, you'll set clear, achievable goals for therapy. These goals are based on your initial concerns and the insights gained during the assessment phase. They might include reducing the frequency of certain behaviors, facing specific fears, or learning new coping strategies.
  • Developing a treatment plan: With goals in place, your therapist will propose a customized treatment plan. This plan outlines the techniques and exercises you'll use, such as exposure tasks, practice assignments outside of therapy, and skills training sessions.

Some therapists will work with you during exposure therapy and the exercises will begin in sessions, so you have the support of a therapist. If exposure therapy work is to be done as an assignment outside of therapy, many mental health professionals may help you to develop a plan that includes the support of a loved one or partner as well as how you will process the exposure you've had to your trigger.

Progress Through Therapy

As you delve deeper into your therapy journey, you'll actively engage with and apply the techniques your therapist introduces. This phase is crucial for mastering the skills necessary to manage and overcome your challenges. Here's what you can expect as you make progress through therapy:

  • Engagement in therapeutic techniques: You'll actively engage in the techniques discussed, which might include facing feared situations in a controlled manner or practicing new behavioral responses to anxiety-inducing stimuli.
  • Monitoring and feedback: Throughout your therapy, your progress will be monitored, and adjustments to the treatment plan will be made as needed. This ensures the therapy remains effective and responsive to your evolving needs.
  • Skill development: A significant part of the journey is learning new skills for managing behaviors and emotional responses. These skills are not only applicable to current concerns but are also valuable for handling future challenges.
  • Goal review and adjustment: As you progress, you and your therapist will regularly review your goals, celebrating successes and recalibrating as necessary.

Conclusion of Therapy

Concluding your therapy journey marks a significant milestone in your personal growth and healing. This phase is about reflecting on the journey, consolidating your gains, and planning for a future where you can apply what you've learned independently. Below are key aspects of concluding your therapy effectively:

  • Review of progress: Towards the end of your therapy, you'll review your progress toward the initial goals, reflecting on the changes made and the skills learned.
  • Planning for the future: You'll discuss strategies for maintaining your improvements post-therapy and how to address potential setbacks independently.

Supportive Follow-Up

Some therapists offer follow-up sessions after the formal conclusion of therapy to check in on your progress and provide additional support if needed.

Embarking on behavioral therapy is a journey of self-discovery and growth. With each step, you'll gain valuable insights and skills that empower you to manage your behaviors and emotional responses more effectively, leading to a healthier, more fulfilling life.

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